United States: Day Three Notes – JP Morgan Healthcare Conference, San Francisco

Yesterday's conference sessions surfaced interesting questions and approaches regarding the post-acute sector, bundled payment, emergency medicine and anesthesia.

Post-Acute Focus: With more and more focus on the need to rationalize and re-organize the post-acute sector, we have seen multiple industry leaders start to evolve their strategies.  I blogged yesterday about AccentCare's interesting strategy in the home health/personal care space, and United, through its Optum subsidiary, has been focused for several years now on rationalizing the post-acute continuum of care.

Yesterday, I was interested and surprised by TeamHealth's presentation. With their $1.6 billion completed acquisition of hospitalist company IPC, I expected to hear more about bundled solutions selling in the acute inpatient market as a result of the IPC capabilities. Instead, the focus of the majority of the TeamHealth presentation was on the post-acute sector. They believe that the most valuable asset in the IPC portfolio is the post-acute service base.  IPC currently provides SNFist and other services to approximately 2,400 of the current 15,000 post-acute facilities in the United States.  Management of the post-acute sector is seen by TeamHealth as being integral to the acute hospital solution set, so as to better be able to coordinate care both in and beyond the hospital, succeed with value-based reimbursement, reduce leakage, position for bundled payments and service the patient throughout an episode of care.  They are serious, noting that they generally would emphasizing post-acute acquisitions over hospitalist acquisitions in the near future.  This approach also starts to de-risk TeamHealth from its high emergency medicine customer concentration.  It also allows for value creation as the nation starts to move towards greater scale in bundled payment programs and allows TeamHealth to position better for sustaining margin with bundled payments (i.e., not just be a price-taker).  The approach also is a potential response to the continuing payor consolidation in the market – by being relevant across more facilities and more service lines, there is a better opportunity for positioning with payors both regionally and nationally.

Bundled Payments: Clearly, bundled payments was one of the themes of the conference. In addition to the above with TeamHealth, both Kindred and HealthSouth were asked questions about possible impact on their business and margins from the implementation of bundled payment programs. As publicly reported in Modern Healthcare today, both companies indicated that very little of their current business would be impacted negatively, if at all, by the bundled payment programs.

Ambulatory Surgery Center please with a side of Physician Services: It was interesting to hear the AmSurg presentation yesterday and their characterization of the Sheridan acquisition.  After relating how the growth in the number of ambulatory surgery centers (ASCs) was relatively flat currently, with about 1 ASC per acute hospital on average in the United States (about 5600 ASCs now, per AmSurg), AmSurg focused on the ability with Sheridan to capture revenue gaps and to provide more complete solution sets.  On the revenue gaps, AmSurg noted in its presentation that the AmSurg ASC portfolio generates approximately $250 million per year in anesthesia revenue, and 95% of the anesthesia services at its multi-specialty ASCs are outsourced to non-AmSurg anesthesia providers.  Clearly an in-fill ability to address.  The recent Arizona acquisitions by AmSurg of an emergency medicine group and an anesthesia group (at what is rumored to be a high multiple in the anesthesia market) provided an example of how AmSurg is looking to cluster around selected hospital facilities and to build or buy physician networks that allow it to vertically integrate and position itself for managing surgical episodes of care.  AmSurg puts itself as growing strongly behind TeamHealth and Envision in the emergency medicine sector and being roughly the same size as Mednax in the anesthesia sector.

Anesthesia Wakes Up: As noted in multiple recent articles, the anesthesia sector has become very active. Given the increased insurance coverage from Medicaid expansion and the exchanges and the increasing life expectancy of Medicare members, we expect to see more and more procedures over a person's lifetime, which clearly makes anesthesia relevant. Given the above trend toward perioperative surgical homes and management of surgical episodes of care (whether through bundles or otherwise), one market thesis is that anesthesia companies can step into that coordination and management role and create value.  U.S. Anesthesia Partners (USAP), a Welsh Carson portfolio company, made its JP Morgan conference debut yesterday.  They have shown rapid growth with multiple acquisitions of larger, high-quality anesthesia groups in Texas, Florida and Colorado.  It's an interesting model, with true alignment built in between the company and the physicians.  All physician partners have equity of the same exact type as Welsh Carson, and physicians proportionally share in the growth or problems of the company.  Additionally, physicians retain significant input and control in operations and governance, making it one of the most physician-centric private equity sponsored healthcare companies in the market today.  USAP is facing significant competitors (such as Mednax, North American Partners in Anesthesia (NAPA), AmSurg, and others), but the sector still is relatively fragmented and many smaller consolidators have not successfully scaled and will present second-wave acquisition opportunities.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Events from this Firm
17 Oct 2017, Seminar, California, United States

Please join us for Sheppard Mullin's Labor & Employment Law Update & Happy Hour Seminar Series. 2017 presents significant developments in California labor and employment laws that will affect the way you run your day-to-day business operations. We will provide analysis and insight on these new laws, as well as offer practical advice and helpful tools for employers to protect their organizations from liability in the workplace.

17 Oct 2017, Seminar, California, United States

Covering topics such as promotions and sweepstakes, mobile advertising challenges, privacy considerations, claim substantiation and more, this expansive program will equip you with the tools you need to practice advertising law today.

18 Oct 2017, Seminar, Santa Clara, United States

The All Hands Meeting is a unique, multifaceted and affordable annual event tailored to the special needs of in-house professionals whose companies rely upon intellectual property. Scores of cutting-edge CLE presentations address the spectrum of legal, regulatory and ethical issues this community faces on a daily basis.

In association with
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at enquiries@mondaq.com.

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.